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History of community
medicine
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Medicine in antiquity
Dubos said the ancient medicine was mother of
science
medicine was concieved in sympathy andborned out of necessity
First doctor was man and first nurse was female
Disease due to wrath of God , evil spirit,influence of stars -- supernatuaral theory
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Indian medicine
Ayurveda and siddh
dhanvantari god of Hindu medicine born by churning of
occean during war
Atharvaveda developed to ayurveda
Atreya first great Indian physician in bhuddist time
Charaka chraka samhita mention 500 drugs
Susruta father of Indian surgery , wrote susruta samhitaincude medicine, pathology, ophthalmology , bebside
manners, fractures , excised tumor etc
Vaghbhatt
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Introduction
Public health is a modern concept, although it has
roots in antiquity.
From time immemorial man has been interested intrying to control disease.
The medicine man, the priest, the herbalist and
magician, all undertook in various way to prevent and
cure disease.
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Evolution of Medicine
Every culture had developed a system of medicine andmedical history is an aspect of history of culture
Ancient medicine was the mother of sciences andplayed a large role in the integration of early culture
Medicine improved as civilization and development
evolved
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Theories of diseases
Supernatural theory of diseases
Theory of humors
Theory of contagion
Miasmic theory
Theory of spontaneous generation Germ theory of disease
Concept of multifactoral causation
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Introduction
What is Public health?
the science and the art of preventing disease,
promoting health and prolonging life through theorganized efforts and informed choices of society,
organizations, public and private, communities and
individuals.
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PHASES IN DEVELOPMENT OF
PUBLIC HEALTHDisease control phase (1880 1920)-Sanitary legislation & sanitary reforms
-control of mans physical environment
Health promotion phase (1920-1960)-provision of personal health services ; maternal & child
health, school health, industrial health, mental health, etc
-provision of primary health centers and sub centers
-inauguration of community development programmes
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PHASES IN DEVELOPMENT OF
PUBLIC HEALTH
Health promotion phase (1920 -1960)--- provision of
personal services; maternal & childhealth, school health, industrial health,
etc --
-provision of basic health services ,
building prymary health centers
---community development
programmes
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Phases ctnd
Social engineering phase (1960 -1980) ---priority shift to social and behavioural aspect of
diseases ---
emergence of concept of risk factors ---preventive & rehabilitative aspect of chronic
diseases
Health for all phase (1981 -2000 AD)
---Attempt to correct imballance between richand poor countries
1981 WHO declaration for health for all by
2000
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where we are
Primary health care
1978 Alma Ata declaration of WHO
The Millennium Development Goal
Sept 2000 millennium summit in New York
Health a developmental issue
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community
a community can encompass several
interpretations such as a village,
subdistrict, district, province, or nation. This can be a country, province, district, or
state
A community is not a static entity
a socially defined group, such as poor
communities
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Community medicine
While medicine evolve along individual
lines over the ages it has also evolve
along community lines Man has understood the importance of
collective living in the aetiology (interaction
leading to communicability of diseases) aswell as management of diseases through
organized efforts
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Community health/
medicine Community health deals with all the servises that
is aimed at protecting the health of the community
Preventive
Promotive
Curative
Rehabiltative
Community medicine looks at the medical andclinical servises provided by physician and nursesbut in a defined community
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Modern public health
Multidiscilpinary
Multisectoral
Evidence based
Equity oriented
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Community diagnosis
This is process of collection and collation
and analysis of health data and indices in
a community for the purpose ofunderstanding the health status of the
community on general or specific issues
It is an important concern of communityhealth
The unit of interest is the community
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Community diagnosis
first task to define health and disease burdenin a given community is to define the targetcommunity.
This can be a country, province, district, orstate
more defined geographical region, such asan urban inner city, or a socially definedgroup
such as poor communities, women in thereproductive age range, pregnant mothers,infants, young adults, or the elderly
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Health indicators
The definition of indicators is a pre-
requisite for the development of an
effective information system in communitydiagnosis. Indicators have to reflect the
kind of decisions which will be needed to
estimate the burden of illness and thestrategies for control
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The main health indicators are expressed interms of crude age-adjusted or age-specific
mortality rates ( infant mortality rates,mortality for children under 5, MMR),disease-specific morbidity rates, and lifeexpectancy at birth.
other indicators have been developed.potential years of life lost, quality-adjusted lifeyears gained, disability-adjusted life years,healthy life years lost, and disabilities and
quality of life index
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Characteristics of community
diagnosis ability to address important problemsamenable to practical control
ability to identify most of the target healthevents
adequacy in reflecting changes in distributionof events over time, place, and person
having a clearly defined population, datacollection, data flow, analysis, interpretation,
and feedback orientation towards appropriate action
being participatory, uncomplicated, sensitive,timely, and inexpensive.
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Sources of information for community
diagnosis
Routine reporting from health facilities Surveillance including active, passive, and
sentinel surveillance
Screening Special surveys
Rapid surveys
Contact tracing Vital registration
A combination of several methods
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Routine reporting system
Birth and death registration
Hospital morbidity and mortality records
At risk register
Disease registers e.g. cancer register
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Surveillance
a tool for community diagnosis of diseases
which have the potential to become an
epidemic Three types of surveillance can be used to
diagnose the nature and extent of a health
problem in a community: activesurveillance, passive surveillance, and
sentinel surveillance.
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Active surveillance
to detect without delay the introduction ofchange in incidence of a specific diseaseagent
to alert pubic health officials early about animpending epidemic
to assess the extent of the risk oftransmission of a particular disease
to estimate and monitor the effectiveness ofcontrol activities.
active surveillance is usually disease specific
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Passive surveillance
useful for monitoring long-term secular trends
but is relatively insensitive to tracking
epidemics. Most countries have a passive surveillance
system.
The key components of a passivesurveillance system include the use of
standardized case definitions and a
standardized reporting system.
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Sentinel surveillance
sentinel surveillance system is used to
identify rapidly changing health problems
in a country or community the objective is to track an approximate
pattern or trend of the situation on which to
base interventions
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screening
Detection of diseases among apparently
healthy individuals using a rapid tool
The objective of a screening programme isto detect health problems at an early stage
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Contact tracing
Contact tracing is particularly useful when
information from routine systems and
surveillance suggests the need for aclarification of the pattern of the spread of
disease
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Purpose of contact tracing
Confirm diagnosis and find causes
Behaviour risk estimates
Estimate magnitude of problems Identify possible control measures
Identify where/to whom to apply control
measures Recommend control measures
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A bi ti f l th d
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A combination of several methods: an
example
All academic disciplines for community
diagnosis have both strengths and
weaknesses. To solve a public health problem
adequately requires inputs from several
disciplines and approaches
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CONCLUSION
DESPITE THE ATTRACTION IN THE
FIELDS OF CLINICAL MEDICINE THE
COMMUNITY PHYSICIAN WILL REMAINTHE CUSTODIAN OF THE PEOPLES
HEALTH FOR HE ALONE REALISES
THAT ULTIMATE POWER MUSTRESIDE WITH THE PEOPLE